Leishmaniasis is an imported disease in the Netherlands. We report data for the period between 2005 and 2012, on clinical presentation, country where leishmaniasis was acquired, and causative species, for 195 civilian and military patients who had travelled abroad. Most patients were affected by cutaneous leishmaniasis (CL) (n=185 patients), while visceral leishmaniasis (VL) (n=8 patients) and mucocutaneous leishmaniasis (n=2 patients) were less frequently observed. All VL patients had been infected in Europe. CL was mainly acquired in Afghanistan, Surinam, Morocco and Spain. The majority of CL patients consisted of military personnel (55%, 102/185), 78 of whom had been infected during an outbreak in Afghanistan. Parasitological diagnosis was made by a combination of polymerase chain reaction (PCR), microscopy and culture. Compared to a standard of parasitological proof by any method other than the one under consideration, sensitivities of the individual methods ranged from 73% to 98%. Microscopy was least sensitive, but is fast and cheap. Mini-exon repeat PCR combines high sensitivity and specificity, and allows differentiation between species by sequencing of the PCR product. Eight different species or species complexes were identified, allowing species-specific therapy. Four patients proved infected with Leishmania naiffi, a hitherto rarely described cause of leishmaniasis. In comparison to previous decennia, an increase in cutaneous leishmaniasis was observed in our hospital, both in civilian and military patients who had travelled abroad. This calls for increased awareness among clinicians, availability of diagnostic tests and species-specific treatment guidelines in non-endemic countries.
Abstractobjectives The aim of this study was to assess the applicability and benefits of the new WHO dengue fever guidelines in clinical practice, for returning travellers.methods We compared differences in specificity and sensitivity between the old and the new guidelines for diagnosing dengue and assessed the usefulness in predicting the clinical course of the disease. Also, we investigated whether hypertension, diabetes or allergies, ethnicity or high age influenced the course of disease.results In our setting, the old classification, compared with the new, had a marginally higher sensitivity for diagnosing dengue. The new classification had a slightly higher specificity and was less rigid. Patients with dengue who had warning signs as postulated in the new classification were admitted more often than those who had no warning signs (RR,). We did not find ethnicity, age, hypertension, diabetes mellitus or allergies to be predictive of the clinical course.conclusions In our cohort of returned travellers, the new classification system did not differ in sensitivity and specificity from the old system to a clinically relevant degree. The guidelines did not improve identification of severe disease.
1 found that treatment with statins was associated with regression of coronary atherosclerosis (assessed by intravascular ultrasonography) when low-density lipoprotein cholesterol (LDL-C) was substantially reduced and high-density lipoprotein cholesterol (HDL-C) was increased by more than 7.5%. The authors state that it remains to be determined whether these changes translate to improved clinical outcomes because the small increases in HDL-C observed during statin therapy have never been shown to correlate with clinical outcome.However, in a post hoc analysis of the secondary coronary heart disease prevention Greek Atorvastatin Coronary Heart Disease Evaluation (GREACE) Study, the composite end point of all vascular events was found to be partly determined by the extent of atorvastatin-induced HDL-C increase in the structured care group compared with usual care. 2 This was in the setting of achieving an LDL-C level of 100 mg/dL (2.59 mmol/L) in 95% of patients in the structured care group (a 46% decrease in LDL-C from baseline values). After multiple regression analysis, the beneficial effect associated with HDL-C increase was independent of the LDL-C reduction (hazard ratio for each 4 mg/dL [0.10 mmol/L] increase in HDL-C, 0.85; 95% confidence interval, 0.76-0.94; P = .002). 2 A relatively small increase in HDL-C (mean, 7%) observed during 3 years of statin treatment was associated with clinical event reduction, supporting the findings of Nicholls et al. 1
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